Seasonal Affective Disorder (SAD) Clinical Presentation

Updated: Dec 09, 2020
  • Author: David R Michael, DO; Chief Editor: Ana Hategan, MD, FRCPC  more...
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About 70% of depressed people feel worse/complain of more intense symptoms during the winter and less intensive symptoms during the summer. To meet the DSM-5 diagnostic criteria for major depressive disorder with seasonal pattern, depression should be present only at a specific time of year (e.g., in the fall or winter) and full remission occurs at a characteristic time of year (e.g., spring). [1] An individual should demonstrate at least 2 episodes of depressive disturbance in the previous 2 years, and seasonal episodes should substantially outnumber nonseasonal episodes. Winter-onset SAD is more common and is often characterized by atypical depressive symptoms including: hypersomnia, increased appetite, and craving for carbohydrates. On the other hand, spring/summer SAD is also seen and is more frequently associated with insomnia and loss of appetite. [3]

Cases where there is an obvious effect of seasonally related psychosocial stressors (e.g., seasonal unemployment, or specific anniversaries or losses) do not meet the diagnostic criteria. For example: Tom works a seasonal construction job that he enjoys. Living in a northern climate, work is much more slow in the winter and he notices that his mood is more down when he is less busy and does not have the money to do the activities that he most enjoys.  

Diagnosing seasonal affective disorder in children is difficult because they experience the recurrent universal stressor of beginning school every autumn.